TiZO Wholesale Account Request

Thank you for your interest in becoming a TiZO reseller. TiZO products are designed for sale through licensed medical and licensed aesthetic practices.Please complete the form below as accurately as possible, upload a copy of your state-issued professional license, upload a copy of your state resale certificate (or equivalent)* and submit.

Please note that a student ID or card will not be recognized as a professional license. A TiZO representative will confirm account setup via email within two business days.We look forward to working with you! Need help or have a question? Please contact: info@tizoskin.com

Account Contact Name*

First NameLast Name

Business or name of practice*

Company Email*

example@example.com

Phone #*

Fax #

Website/Social Media Handle(s)*

Professional Specialty*

Do you already retail TiZO Products?

YesNo

Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How did you hear about us?

Social MediaMagazineSearch EngineOther

Would you like to receive emails about promotions and/or newsletters?*

YesNo

Would you like to opt into TiZO Skincare Professional Locator?*

YesNo

Have a Promo Code? Enter Below!

Upload Professional License (Example: Physician, Esthetician..)*

Upload State Resale Certificate (Or Equivalent)*

TiZO Wholesale Account Request

Dispensing Practice Agreement